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Corneal cross-linking patients need Medicare rebate


Ultraviolet light source irradiating the cornea soaked with riboflavin

Photo: Clin Exp Optom 2013; 96: 2: 155-164


By Helen Carter

The Department of Health has received a request for Medicare benefits for patients undergoing corneal cross-linking as early intervention in progressive keratoconus.

A spokeswoman for the department confirmed that a proposal for an application requesting MBS listing of corneal collagen cross-linking for patients with keratoconus who were showing evidence of progression had been received.

‘Should the proposal proceed for consideration through the Medicare Services Advisory Committee process, a consultation protocol for the application will be published on the MSAC website and public submissions invited,’ she said.

The application stated that although corneal transplantation was a successful treatment, it was a major operation with potentially serious risks to good vision, and a treatment to slow progression was clearly desirable.

Consultant ophthalmologist at the Royal Victorian Eye and Ear Hospital and Honorary Research Fellow with the Centre for Eye Research Australia (CERA), Dr Elsie Chan, has been involved in the world’s first randomised controlled clinical trial of corneal cross-linking at CERA.

She was a co-author in a recent paper reporting on the trial.* The paper reported on outcomes three years after cross-linking in 48 control and 46 treated eyes of patients with progressive keratoconus.

At 36 months, there was a sustained improvement in maximum simulated keratometry value, uncorrected visual acuity and best spectacle-corrected visual acuity in the treated group, whereas the control group demonstrated further progression.

Dr Elsie Chan

Dr Elsie Chan

Dr Chan said a Medicare rebate was needed because the procedure would hopefully help prevent progression of disease and the need for corneal transplants.

Cross-linking would also hopefully help prevent the need for costly rigid contact lenses and associated costs of repeated visits and updated lenses, she said.

‘Patients currently pay out of pocket or have it done via a public hospital if the hospital offers the treatment without cost to the patient,’ Dr Chan said.

She said no-one knew how many Australians had keratoconus. The quoted incidence was 1:2000 but this was not necessarily for an Australian population and people are being diagnosed much earlier now.

Cross-linking was first described about 12 years ago. It involves soaking the cornea with a solution of riboflavin and dextran.

A UV-A light source is shone onto the cornea and the effect is to increase intermolecular bonds between collagen fibres and stiffen the cornea, reducing the risk of progression of ectasia.

Keratoconus Australia president Larry Kornhauser said waiting lists for corneal cross-linking are long.

‘The application to the Department of Health is probably overdue as many patients are finding it difficult to access this potentially useful procedure because of its high cost, which averages around $2,500 per eye,’ he said.

‘Keratoconus Australia would support a rebate for the cross-linking procedure when done under clinically proven protocols that can be demonstrated by ophthalmologists to be both safe and effective in the long term.

‘However, there is an increasing range of variations of the procedure, mostly unproven, and patients and their families are bewildered by the array of options being offered by corneal surgeons in Australia,’ he said.

Dr Chan indicated in a seminar in 2013 that results showed that cross-linking slowed and might halt progression of keratoconus with a small risk of complications, and variations to the procedure had been performed.

She said at the seminar that there was no evidence of benefit to those not experiencing demonstrable progression.


*  Wittig-Silva C, Chan E, Islam FM, Wu T, Whiting M, Snibson GR. A randomized, controlled trial of corneal collagen cross-linking in progressive keratoconus: three-year results. Ophthalmology 2014; 121: 812-821

13 comments for “Corneal cross-linking patients need Medicare rebate”

  1. Gravatar of Natalie MollerNatalie Moller
    Posted Sunday, May 24, 2015 at 9:53:40 AM

    My son is 25 and has had keratoconus for 5 years. The right eye was affected now the left eye is a problem. He plays competitive football. The hard lens are uncomfortable. We live in country Victoria. Where can he go for the collagen X linking.

  2. Gravatar of Paul MinersPaul Miners
    Posted Sunday, June 28, 2015 at 12:38:36 AM

    I have Keratoconus in my right eye and can't wear rigid lenses. What is the progression with the Medicare rebate and where can I get this treatment done?

  3. Gravatar of Mariam SorrorMariam Sorror
    Posted Friday, July 24, 2015 at 11:22:31 PM

    I have keratoconus in my both eyes, the left is in a bad condition and the situation is getting worse in only two month, the shape of the corneal start changing in a very short time and as a family we can not afford that high cost for the cross linking.

  4. Posted Thursday, October 1, 2015 at 7:34:50 PM

    good procedure of cross linking,,Excellent discussion.

  5. Gravatar of sue hickman sue hickman
    Posted Thursday, November 12, 2015 at 8:33:03 PM

    I have keratoconus in both eyes I am . having crosslinking done but then I will probably have to have the rings put in .I am in private health why is there no item number so we can claim ?

  6. Gravatar of Luke ArundelLuke Arundel
    Posted Friday, November 13, 2015 at 4:37:30 PM

    Hi Sue.
    It generally takes many years for new procedures to obtain either a Medicare item number or Private Health fund rebate. Health funds respond to the needs of their members. While keratoconus is rare, if you feel this treatment should be covered by your policy, then write to your fund directly and make your concerns heard. I suggest joining Keratoconus Australia ( which is a representative group for keratoconus patients to improve health rebates for treatments (contact lenses and solutions, glasses) and corneal surgery, and to obtain higher funding for local research into the condition and recognition of keratoconus as a disability.

    Luke Arundel, resident optometrist, Optometry Australia

  7. Gravatar of Ed GreenrodEd Greenrod
    Posted Friday, January 22, 2016 at 12:26:53 PM

    Corneal cross linking is currently available as a public patient through the corneal unit at the Alfred Hospital in Melbourne. It is also available through the Eye and Ear hospital. Patients do require a referral from their GP or Optometrist to attend the service at either hospital.

  8. Gravatar of BaileyBailey
    Posted Friday, May 27, 2016 at 5:26:23 PM

    I've got Keractaconus and I am 15. What do I do. Will I have general anaesthetic or local anaesthetic. I would prefer general. Is this possible

  9. Gravatar of ali makkiali makki
    Posted Friday, June 10, 2016 at 2:15:33 PM

    can you inform me of the complications in cross linking and would your eyesight have a chance of getting better and becoming 100 percent

  10. Gravatar of Tracy BarlingTracy Barling
    Posted Wednesday, June 22, 2016 at 4:45:26 PM

    Several years after having laser surgery to correct poor vision, I developed Kerataconus which was later diagnosed as Pellucid Marginal Degeneration of the Cornea. I saw a specialist in Brisbane who performed Corneal Collagen Cross-linking in my left eye. I was skeptical after being told when I had the original laser that I was a perfect candidate for that procedure. Two years after the cross-linking, my left eye is very stable and clear with my glasses prescription, which has improved slightly. My right eye is very blurry now with that same prescription and I will get it done next as the results are worth it. Very expensive though, and also very painful during recovery, which took over a week.

  11. Gravatar of ZOHEB Imran AliZOHEB Imran Ali
    Posted Thursday, April 6, 2017 at 12:37:50 PM

    I am from Fiji And am suffering from Ketroconous and was seen by an Australian eye specialist who recommended a Corneal Eye cross linking.I am not able to with the cost.Please my humble request for help,if I could be helped by some merciful person.I am 27 years old and Need help as soon as possible.God Bless.

  12. Gravatar of HelenHelen
    Posted Saturday, April 29, 2017 at 5:08:49 PM

    I have booked in for Corneal Cross Linking with a private specialist. The fact that there is no item number for a procedure being done weekly to preserve people's eyesight is pathetic. I am registered with Medicare ( full taxpayer) and have top hospital private cover but I have to pay full cost with no rebate. This is not cosmetic it may arrest my eye disease and stop me from becoming vision impaired in the future ( if that was to happen I would almost certainly go on a disability plan). Wake up Australia why are you paying for surgical removal of tattoo's but not saving people's eyesight?

  13. Gravatar of anthony foxanthony fox
    Posted Monday, September 25, 2017 at 6:37:52 PM

    Didn't know I had until a vision test in High school (14 years old.Where it was finally identified in one eye. Prescribed hard lenses. couldn't tolerate them. progressed to both eyes now, I get by wearing glasses. (aged 42)
    This surgery could change my life. get with it Medicare!

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